AccountId: 011433970860
ContactId: 097658bc-6ee7-49b3-b01d-1b82b440cb45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 687140 ms
Total Talk Time (AGENT): 254007 ms
Total Talk Time (CUSTOMER): 162513 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/097658bc-6ee7-49b3-b01d-1b82b440cb45_20250616T12:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from a provider's office to see if the patient has dental benefits and if we're in network.
[AGENT][POSITIVE] OK, I'm happy to check benefits. What is the member's policy number? Do you have that?
[CUSTOMER][NEUTRAL] She gave me five digits. I don't know if that's it, but she gave me 60801.
[AGENT][NEUTRAL] OK, that's no, that's our payer ID um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let's see, we
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] We can search by name or social. Do you have either of those?
[CUSTOMER][NEUTRAL] I have her name, um, it's hyphenated, so the first name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the second last name is [PII]
[AGENT][NEUTRAL] OK. Let's see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then, [PII], can I get um the insured's date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] All right, thank you. So patient does have an active plan. Do you want the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] Alright. Active policy is 02608684.
[AGENT][NEUTRAL] And the effective date on here is [PII].
[CUSTOMER][NEUTRAL] OK and um does it show that we're in network with you guys?
[AGENT][NEUTRAL] So on the patient plan it doesn't look like there's any sort of network required for usage it just pays by UCR so if you need us to we can send you a fax back with a breakdown.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, what would be the address for claims?
[AGENT][NEUTRAL] Uh, the address is [PII].
[AGENT][NEUTRAL] And that's in [PII] City, [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] And um does she have a group name and number?
[AGENT][NEUTRAL] Yeah, let's take a look here.
[AGENT][NEUTRAL] Group name is Universal Trucking.
[AGENT][NEUTRAL] And the group number is 14,900.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I just have specific questions about her plan if that's OK.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK, does she have a calendar or fiscal plan?
[AGENT][NEUTRAL] It's a calendar year.
[CUSTOMER][NEUTRAL] And is there a waiting period or missing tooth cloths?
[AGENT][NEUTRAL] There is a waiting period on any major endoper or oral surgery, which is 12 months.
[AGENT][NEUTRAL] Uh, the policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] An appointment
[CUSTOMER][NEUTRAL] OK, and what is her yearly maximum and deductible and if she's used or met anything?
[AGENT][NEUTRAL] Her calendar year maximum is gonna be 1500.
[CUSTOMER][NEUTRAL] This.
[AGENT][NEUTRAL] Her calendar year deductible is going to be $50.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] And let me just check and see if she's used anything here, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right, so it looks like the patient has $50 deductible remaining and the full $1500.
[CUSTOMER][NEUTRAL] OK, and does preventive and diagnostic come out of the yearly maximum?
[AGENT][NEUTRAL] Uh, yes, it looks like preventative just does not apply towards the deductible, excuse me.
[CUSTOMER][POSITIVE] No, it's OK have a nice day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I have a few codes. Would you like them all at one time or individually?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Whatever works best for you. You can give them to me all at once. I'll copy them down.
[CUSTOMER][NEUTRAL] OK, and then, um, OK, I'll give you those and then I just need the coinsurances like for basic major and um preventative, but the first one is 0330.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 0140.
[CUSTOMER][NEUTRAL] 9310.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 0367.
[CUSTOMER][NEUTRAL] 9222.
[CUSTOMER][NEUTRAL] 923 9.
[CUSTOMER][NEUTRAL] 9230.
[CUSTOMER][NEUTRAL] 961 2.
[CUSTOMER][NEUTRAL] 70 to 10.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7220.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 70 to 30.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And 70 to 40.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So on here, preventative is covered at 100% of UCR.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic is gonna be covered at 80%.
[AGENT][NEUTRAL] And then any major which includes endoerio or oral surgery, excuse me, I can't speak this morning, it's 40%.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Alright, and then 0330 is gonna be covered at 80%.
[AGENT][NEUTRAL] Looks like it does have a limitation. Give me just one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's limited to 1 X-ray procedure for 5 years, it looks like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0140 is also gonna be covered at 80%.
[AGENT][NEUTRAL] It is limited to 2 oral evaluations in any 12-month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9310 is covered at 80%. There is no limitation on that.
[AGENT][NEUTRAL] 0367.
[AGENT][NEUTRAL] I do not see 0367 listed so therefore it would not be a covered a benefit.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9222 is also not listed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I do not see 9239 either.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2:30.
[AGENT][NEUTRAL] 9230 is covered at 40%. I do not show any limitation on it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] 9612 is not listed, therefore not covered.
[AGENT][NEUTRAL] 7210 is covered at 40% with no limitation.
[AGENT][NEUTRAL] Same for 7220.
[AGENT][NEUTRAL] 7230.
[AGENT][NEUTRAL] And 7240, all covered at 40%, no limitation.
[CUSTOMER][NEUTRAL] OK, and when they are covered, would they all go straight through dental or do they need to go through medical first, the instructions?
[AGENT][NEUTRAL] Um, they can come straight to us or go to their medical first. It does, it doesn't matter.
[CUSTOMER][NEUTRAL] OK, and she has no history, right?
[AGENT][NEUTRAL] Um, let me just double check. I'm not certain. I didn't see, probably.
[CUSTOMER][NEUTRAL] I don't think so because.
[AGENT][NEUTRAL] Yeah, it's so new. Yeah, I know she doesn't have anything on file.
[CUSTOMER][NEUTRAL] OK, and then last question, the 90 to 30, are there any guidelines to use that code?
[AGENT][NEUTRAL] Uh, let's see, I don't believe there were 9230.
[AGENT][NEUTRAL] No, there's not. Mm mm.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] Alright, and then I just need a reference number.
[AGENT][NEUTRAL] Absolutely. Call references my name with today's date. My name again is [PII], that's [PII] Initial to my last name is [PII] and then today's date.
[CUSTOMER][NEUTRAL] You talked to that [PII].
[CUSTOMER][NEUTRAL] Is that [PII], the one you texted me about.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] And you said the payer ID is the 60801?
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][POSITIVE] 6080 OK perfect thank you so much and have a great day.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][POSITIVE] Thank you bye.